MAKE ONLINE APPOINTMENT

Name*

FirstMiddleLast

Have you ever gone by another name?*

Yes

No

Former/Past Names Used

FirstMiddleLast

Are you over the age of 18?

Yes

No

We apologize, but donors under the age of 18 are unable to schedule appointments online. Please complete and bring in the Parental Consent Form to your nearest donation center in order to make a donation.

Date of Birth*

MM

DD

YYYY

Will this be your first time donating with The Central California Blood Center?*

Yes

No

We apologize, but first-time donors are unable to schedule appointments online. Please complete and bring in the New Donor Form to your nearest donation center in order to make a donation.

MAKE ONLINE APPOINTMENT

MAKE ONLINE APPOINTMENT

Name*

FirstMiddleLast

Have you ever gone by another name?*

Yes

No

Previous Names Used*

FirstMiddleLast

Are you over the age of 18?*

Yes

No

We apologize, but donors under the age of 18 are unable to schedule appointments online. Please complete and bring in the Parental Consent Form to your nearest donation center in order to make a donation.

Date of Birth*

MM

DD

YYYY

Will this be your first time donating with The Central California Blood Center?*

Yes

No

We apologize, but first-time donors are unable to schedule appointments online. Please complete and bring in the New Donor Form to your nearest donation center in order to make a donation.

DON'T KNOW YOUR BLOOD TYPE?

You’re not alone. About 70% of Americans don’t know their blood type either. But that doesn’t make it any less important to donate blood regularly. Because you never know, one day you could be the local resident in need. Donate Blood Now.

YAY! YOU KNOW YOUR BLOOD TYPE.

Congratulations! You are one of only 30% of Americans who know their blood type. So it should be no surprise to you how valuable your blood could be to a local resident in need. Be sure to donate as often as possible.Donate Blood Now.